Provider Demographics
NPI:1376382697
Name:HANNA, MARY (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVENUE-MSC 25 SUNY DOWNSTATE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2021
Mailing Address - Country:US
Mailing Address - Phone:718-270-1291
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVENUE-MSC 25 SUNY DOWNSTATE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2021
Practice Address - Country:US
Practice Address - Phone:718-270-1291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2025-03-03
Deactivation Date:2025-01-14
Deactivation Code:
Reactivation Date:2025-03-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program